Reduction in post-operative acute kidney injury following a change in antibiotic prophylaxis policy for orthopaedic surgery: an observational study
Reduction in post-operative acute kidney injury following a change in antibiotic prophylaxis policy for orthopaedic surgery: an observational study
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DOI：
10.1093/jac/dkw166
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发表时间：
2016-09-01
影响因子：
5.2
通讯作者：
Bell, Samira
中科院分区：
文献类型：
--
作者：
Walker, Heather;Patton, Andrea;Bell, Samira
有证据表明，氟氯西林和庆大霉素预防性抗生素方案用于骨科手术与术后急性肾损伤（阿基）发生率增加相关。这导致骨科手术预防的国家抗生素政策建议发生变化。本研究旨在评估从氟氯西林和庆大霉素到复方阿莫西林的变化是否与AKI和艰难梭菌感染（CDI）发生率的变化相关。使用观察性研究和中断时间序列分析分别评估接受股骨颈（NOF）修复和其他需要抗生素预防的骨科手术患者的术后阿基发生率。发生率比率用于评价CDI率的变化。政策变更后，从氟氯西林和庆大霉素改为复方阿莫西林，其他骨科手术组术后阿基率在18个月时的相对变化为-63%（95%CI-77%至49%）。在NOF修复组中，18个月时术后阿基发生率无变化[-10%（95% CI -35%-15%）]。其他骨科手术组中CDI的发生率比为0.29（95% CI 0.09-0.96），NOF修复组为0.76（95%CI 0.28-2.08）。在骨科手术中使用co-amoxiclav预防抗生素与术后并发症发生率降低相关。与氟氯西林和庆大霉素相比，手术性阿基发生率增加无关。
Evidence has shown that a prophylactic antibiotic regimen of flucloxacillin and gentamicin for orthopaedic surgery was associated with increased rates of post-operative acute kidney injury (AKI). This resulted in changes in the national antibiotic policy recommendation for orthopaedic surgical prophylaxis. This study aimed to assess whether this change from flucloxacillin and gentamicin to co-amoxiclav was associated with changes in the rates of AKI and Clostridium difficile infection (CDI).An observational study and interrupted time series analyses were used to assess rates of post-operative AKI separately in patients undergoing neck of femur (NOF) repair and other orthopaedic operations that required antibiotic prophylaxis. Incidence rate ratios were used to evaluate changes in CDI rates.Following the change in policy, from flucloxacillin and gentamicin to co-amoxiclav, there was a relative change in rates of post-operative AKI of -63% (95% CI -77% to -49%) at 18 months in the other orthopaedic operations group. In the NOF repair group, there was no change in the rate of post-operative AKI [-10% (95% CI -35%-15%)] at 18 months. The incident rate ratio for CDI in the other orthopaedic operations group was 0.29 (95% CI 0.09-0.96) and in the NOF repair group was 0.76 (95% CI 0.28-2.08).The use of co-amoxiclav for antibiotic prophylaxis in orthopaedic surgery was associated with a decreased rate of post-operative AKI compared with flucloxacillin and gentamicin and was not associated with increased rates of CDI.